A medical protocol for Vertigo and Dizziness


Doctors report that they are often poorly trained in vestibular and neuro-vestibular conditions. "Misdiagnosis rates in the Emergency Department for peripheral vestibular disorders are estimated in the range of 74 to 81%. [ Neurologic Clinics]"

Are you a vertigo expert? 

Are you a vertigo expert? Then you are presumably aware of the relatively low level of the Belgian Guidelines for Vertigo treatment in patients (www.ebprnet.be). And the poor Guidelines in other countries as well.

Are you a first line GP? 

It's okay if you are not familiar yet with all vestibular disorders, but it is not okay if you cannot lean on a decent guideline in order to make right decisions for your patient who needs further tests and a decent treatment, right?

As of today, we can identify +12 vestibular diagnoses... 

of which only 3 are listed in the 'guideline': BPPD, Vestibular Neuritis and Ménière's Disease. It is obvious that anno 2020, this information is by far outdated and very incomplete. 

The price we pay

This is not without consequences, since a large group of patients risks to be underdiagnosed and mistreated, with high impact on personal life as well as socio-economically.

Belgian Study Group on Vestibular Disorders (BSGVesD). 

Hence we take the initiative to form a Belgian Study Group on Vestibular Disorders (BSGVesD). The goal of this BSGVesD is to make a guideline for the diagnosis and treatment of Vertigo and Dizziness, that reflect the most recent scientific findings as well as the Barany Society definitions of the different vestibular disorders.

Additionally, in 2020 we want to present the result of this BSGVesD during the Barany Meeting in Madrid, as an example of national guidelines. This could put us as Belgium in a forefront position.

We now took the initiative to invite doctors with different backgrounds to be part of the (multidisciplinary) Belgian Study Group on Vestibular Disorders (BSGVesD). The team should consist of vertigo experts from different disciplines, and cover all clinicians that are confronted with vertigo, thus neurologists, otolaryngologists, ophthalmologists, general practitioners, physical therapists, audiologists, scientists, patients,...

The first meeting will take place in the beginning of November.

Below is the Dutch and French version of the Etiology as stated on the
EB Practice Net webpage in Belgium. We put it in red because it is far outdated.

"Vertigo wordt voornamelijk veroorzaakt door een organisch malfunctioneren. De meest voorkomende oorzaken van vertigo (niet volgens hun frequentie) omvatten:
  • spanning in de nek
  • goedaardige positionele vertigo [>>Richtlijn]
  • orthostatische hypotensie (bij het rechtstaan; gaat vaak gepaard met lage bloeddruk en komt vaak voor bij ouderen)
  • vestibulaire neuronitis (idiopathische acute vestibulaire disfunctie)
  • Ziekte van Ménière [>>Richtlijn]
  • circulatiestoornissen van het cerebellum en de hersenstam (in associatie met andere symptomen)
  • cerebellaire atrofie (meestal geassocieerd met langdurig buitensporig alcoholgebruik)
  • vertigo, gerelateerd aan het verouderingsproces bij ouderen (hersenen, ogen, evenwichtsorganen, perifeer gevoel van houding, orthostatisme)
  • paniekaanval (hyperventilatie)."

"Le vertige est principalement causé par une dysfonction organique. Les causes les plus courantes de vertige (non classées par ordre de fréquence) sont les suivantes :

  • tension cervicale
  • vertige positionnel bénin [>>Guide de pratique clinique]
  • hypotension orthostatique (en position debout, souvent associée à une hypotension artérielle et survient surtout chez les personnes âgées)
  • neuronite vestibulaire (début aigu, dysfonctionnement vestibulaire prolongé)
  • Maladie de Ménière >>[Guide de pratique clinique]
  • troubles circulatoires du cervelet et du tronc cérébral (associés à d'autres symptômes)
  • atrophie cérébelleuse (généralement associée à une consommation excessive d'alcool à long terme)
  • vertiges liés au processus de vieillissement chez les personnes âgées (cerveau, yeux, organes conférant le sens de l'équilibre, sens postural périphérique, hypotension orthostatique)
  • crise de panique (hyperventilation)."